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A healthcare provider is assisting with the care for a client who has a prescription for magnesium sulfate. The provider should recognize that which of the following are contraindications for the use of this medication? (Select all that apply)
- A. Fetal distress
- B. Cervical dilation greater than 6 cm
- C. Vaginal bleeding
- D. All of the Above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Magnesium sulfate is contraindicated in cases of fetal distress, cervical dilation greater than 6 cm, and vaginal bleeding. Fetal distress can be worsened by magnesium sulfate, and it can lead to respiratory depression in the newborn. Cervical dilation greater than 6 cm indicates advanced labor, where the risk of uterine atony and postpartum hemorrhage is increased with magnesium sulfate use. Vaginal bleeding may be a sign of placental abruption or other complications, which can be exacerbated by magnesium sulfate. Therefore, all three options are contraindications for the use of magnesium sulfate in this scenario.
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A healthcare professional is assisting with the care of a client who is receiving IV magnesium sulfate. Which of the following medications should the healthcare professional anticipate administering if magnesium sulfate toxicity is suspected?
- A. Nifedipine
- B. Pyridoxine
- C. Ferrous sulfate
- D. Calcium gluconate
Correct Answer: D
Rationale: The correct answer is D: Calcium gluconate. When magnesium sulfate toxicity is suspected, calcium gluconate is administered because it antagonizes the effects of magnesium on the heart and central nervous system. This helps to counteract the muscle weakness, respiratory depression, and cardiac arrhythmias associated with magnesium toxicity. Nifedipine (A) is a calcium channel blocker and is not indicated for magnesium toxicity. Pyridoxine (B) is a form of vitamin B6 and is not used to treat magnesium toxicity. Ferrous sulfate (C) is an iron supplement and is not relevant in the management of magnesium toxicity.
A healthcare professional is assisting with the care for a client who is experiencing a ruptured ectopic pregnancy. Which of the following findings is expected with this condition?
- A. No alteration in menses
- B. Transvaginal ultrasound indicating a fetus in the uterus
- C. Blood progesterone greater than the expected reference range
- D. Report of severe shoulder pain
Correct Answer: D
Rationale: The correct answer is D: Report of severe shoulder pain. In a ruptured ectopic pregnancy, the fertilized egg implants outside the uterus, usually in the fallopian tube. As the tube ruptures, there is internal bleeding which can irritate the diaphragm, causing referred pain to the shoulder. This phenomenon is known as Kehr's sign. The other choices are incorrect because with a ruptured ectopic pregnancy, there would typically be altered menses due to the pregnancy disruption, a transvaginal ultrasound would not show a fetus in the uterus, and blood progesterone levels would not be elevated.
A newborn was delivered vaginally and experienced a tight nuchal cord. Which of the following clinical manifestations should the nurse expect to observe?
- A. Bruising over the buttocks
- B. Hard nodules on the roof of the mouth
- C. Petechiae over the head
- D. Bilateral periauricular papillomas
Correct Answer: C
Rationale: The correct answer is C: Petechiae over the head. This is because tight nuchal cord can cause pressure on the baby's head during delivery, leading to tiny red or purple spots called petechiae due to capillary rupture. Bruising over the buttocks (A) is more common in breech deliveries, hard nodules on the roof of the mouth (B) could indicate Epstein pearls which are benign and common in newborns, and bilateral periauricular papillomas (D) are not related to nuchal cord compression.
A client has severe preeclampsia and is receiving magnesium sulfate IV. Which of the following findings should the nurse identify and report as signs of magnesium sulfate toxicity? (Select all that apply)
- A. Respirations less than 12/min
- B. Urinary output less than 25 mL/hr
- C. Decreased level of consciousness
- D. All of the above
Correct Answer: D
Rationale: The correct answer is D: All of the above. Magnesium sulfate toxicity can lead to respiratory depression (respirations less than 12/min), decreased urinary output (less than 25 mL/hr), and altered mental status (decreased level of consciousness). Respiratory depression occurs due to the impact of magnesium on the central nervous system. Decreased urinary output is a result of magnesium's effects on renal blood flow. Altered mental status is a common sign of magnesium toxicity affecting brain function. Reporting these signs promptly is crucial to prevent serious complications. The other choices (A, B, C) are incorrect because they are all potential signs of magnesium sulfate toxicity and should be reported.
A client who is 12 hours postpartum has a fundus located two fingerbreadths above the umbilicus, deviated to the right of the midline, and less firm than previously noted. Which of the following actions should the nurse take?
- A. Place the client in a side-lying position.
- B. Assist the client to the bathroom to void.
- C. Obtain a prescription for IV oxytocin.
- D. Administer methylergonovine.
Correct Answer: B
Rationale: The correct answer is B: Assist the client to the bathroom to void. This action can help promote uterine contractions by relieving bladder distention, which can cause the fundus to be displaced. Voiding can help the uterus return to its normal position and firmness. Placing the client in a side-lying position (A) may be helpful for fundal massage but addressing bladder distention is the priority. Obtaining a prescription for IV oxytocin (C) or administering methylergonovine (D) are not indicated as first-line interventions for a fundus located above the umbilicus postpartum.